© Borgis - New Medicine 4/2009, s. 79-81
*Magdalena Fršckiewicz, Lechosław P. Chmielik, Mieczysław Chmielik
BACTERIOLOGICAL AETIOLOGY OF CHRONIC RHINOSINUSITIS IN CHILDREN DURING 2007–2009
Department of Paediatric Otorhinolaryngology, Medical University of Warsaw, Poland
Head of Department: Prof. Mieczysław Chmielik, MD, PhD
Introduction:Chronic rhinosinusitis (CRS) is an inflammatory process affecting the mucosa of the nasal cavities and paranasal sinuses. The inflammation lasts more than 4-6 weeks. The aetiology of CRS is multifactorial. A number of conditions predispose to rhinosinusitis, among others microbial infection.
Aim: To evaluate the bacteriological testing of samples taken from the middle nasal turbinates and lumen of maxillary sinuses of children operated on for chronic rhinosinusitis.
Material and method: The research included 139 children, treated surgically in the Department of Paediatric Otolaryngology, Warsaw Medical University between 2007 and 2009. The material for bacteriological examination was collected during endoscopic sinus surgery from the middle nasal turbinates and maxillary sinuses.
Results: Two diagrams presented below show the most frequent pathogens co-existing with chronic rhinosinusitis in the examined group. Both in the material from the maxillary sinuses and from the middle nasal turbinates Staphylococcus spp. coagulase(-) was cultured most frequently.
Discussion: Chronic rhinosinusitis develops as a result of a composite and multistage inflammatory process. At least one component of the pathogenesis of CRS is bacterial infection. In our research in fairly many cases we have noticed a lack of correlation between the results from the nasal turbinates and from the maxillary sinuses.
Conclusions: 1. The results of bacteriological testing in the examined group differ from the most common aetiology that causes rhinosinusitis described in the literature. 2. The results taken from the middle nasal turbinate in most cases differ from the results taken from the lumen of the maxillary sinuses. 3. Examination of samples taken from the middle nasal turbinates and maxillary sinuses play a vital role in establishing the aetiology of rhinosinusitis and in choosing the exact treatment in case of recurrence of rhinosinusitis.
Chronic rhinosinusitis (CRS) is a common clinical condition. It is caused by a chronic inflammatory process affecting the mucosa of the nasal cavities and paranasal sinuses that lasts constantly for more than 4-6 weeks, and which cannot be cured by pharmacological treatment [1,3,5].
According to Meltzer the symptoms of CRS can be divided into two groups, as major and minor symptoms [4,5]:
Major symptoms include:
– muco-purulent discharge present in the anterior rhinoscopy and/or in posterior nostrils and posterior wall of the pharynx,
– impaired patency of the nose,
– dull headaches.
And minor symptoms include:
– headaches of different character,
– bursting otalgia,
– sub-febrile body temperature,
– fetor ex ore,
Chronic rhinosinusitis is manifested by the presence of at least 2 major symptoms, or 1 major and at least 2 minor symptoms for more than 4-6 weeks.
The aetiology of chronic rhinosinusitis is multifactorial. Repeated acute upper respiratory tract infections can lead to mucosal swelling, obstruction of sinus outflow, and, eventually, chronic infection. A number of conditions predispose to rhinosinusitis, including allergies, decongestant spray abuse (rhinosinusitis medicamentosa), immunoglobulin deficiencies, disorders of mucociliary transport, and changes in glandular secretions. In addition, anatomical factors such as septal deviations, hypertrophic middle turbinates, and concha bullosa can affect the nasal cavity and sinus ostia airflow. Gradually processes occurring in the mucosa lead to impatency of natural openings of the sinuses and disturbance of their ventilation. This causes the retention of infected secretions in the lumen of sinuses [1, 2, 3].
To evaluate the bacteriological testing of samples taken from the middle nasal turbinates and lumen of the maxillary sinuses of children operated on for chronic rhinosinusitis.
MATERIAL AND METHOD
The research included 139 patients with chronic rhinosinusitis (69 females, 70 males), aged 5 to 17, treated surgically in the Department of Paediatric Otolaryngology, of Warsaw Medical University in the period between January 2007 and March 2009. In all cases endoscopic sinus surgery was performed. The material for bacteriological examination was collected during the surgical procedure from both the middle nasal turbinates and from the maxillary sinuses. Inoculation of bacteria was cultured into a medium produced by Biomerieux company. In all cases in which the result of the microbiological examination was positive, antibiograms were made. Results with the antibiogram were attached to the patient´s records in the out-patient clinic in case of aggravation of symptoms of CRS.
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